Organization
PHOENIX SPINE GOODYEAR ASC, LLC
Active
Organization
PHOENIX SPINE GOODYEAR ASC, LLC
Active
Other names
Phoenix Spine Goodyear ASC, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (AO)
(480) 567-0269
Entity
Organization
Contact information
Practice address
140 N LITCHFIELD RD, SUITE 110, GOODYEAR, AZ 85338-1277
(602) 256-2525
(602) 256-0795
Mailing address
140 N LITCHFIELD RD STE 110, GOODYEAR, AZ 85338-1226
(602) 256-2525
(602) 256-0795
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
28519
AZ
208100000X
Physical Medicine & Rehabilitation Physician
35838
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
987125
—
AZ
Enumeration date
11/20/2006
Last updated
09/05/2024
Update your record
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